Gastroenteritis- ix & mx contd

Ix
1. usually none indicated
2. stool culture
  1. if child appears septic
  2. if blood or mucus in stools
  3. if immunocompromised
  4. if recent foreign travel
  5. if diarrhoea hasn't improved by day 7
  6. if diag uncertain
3. if iv fluids needed or features suggestive of hypernatraemia
  1. U&E
  2. glucose
4. if Abx started
  1. blood cultures
Mx
1. fluid management of dehydration
  1. see doc
2. hypernatraemic dehydration
  1. ORS
    1. to rehydrate kids w/ clinical dehydration
  2. if iv fluids needed
    1. a rapid decrease in plasma [Na+] and osmolality will ->
      1. water moving into cerebral cells->
        seizures
        cerebral oedema
    2. reduction in plasma [Na+] should be slow
      1. replace fluid deficit over at least 48 h & measure plasma Na+ regularly
        aim to reduce plasma Na+ at < 0.5 mmol/L/hr
3. NO ROLE FOR ANTI-DIARRHOEALS & ANTIEMETICS
  1. ineffective
  2. prolong excretion of bacteria in stools
  3. can be assoc w/ s/es
  4. add unnecessarily to cost
  5. take focus away from ORS
4. Abx
  1. not routinely required
    1. even if bacterial cause
  2. indications
    1. suspected/confirmed sepsis
    2. extra-intestinal spread of bacterial infection
    3. Salmonella gastritis in <6 months old
    4. malnourished kids
    5. immunocompromised
    6. specific bacterial or protozoal infections
      1. bacteria
        C diff assoc pseudomembranous colitis
        cholera
        shigellosis
      2. protozoa
        giardiasis
Mx
1. nutrition
  1. multiple episodes of diarrhoea predispose to developing malnutrition
    1. in developing countries
  2. increase nutritional intake ff diarrhoea
  3. zinc supplementation in acute diarrhoea & prophylaxis
    1. diarrhoea can be assoc w/ zinc def

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Gastroenteritis- ix & mx contd

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